The Croydon Diagnostics in the Community Pilot

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The Croydon Diagnostics in the Community Pilot
London NHS Diagnostic Service

• Croydon Federation of General Practices and
• London NHS Diagnostic Service

Dr Agnelo Fernandes, GP Croydon FederationDr
David Lyell, GP Croydon FederationAdam Cooper,
NHS London Dominic Conlin, Croydon PCT
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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service

• National Policy context Care Closer to Home
• The Croydon Federation of General Practices and
• The London NHS Diagnostic Service - InHealth
  Netcare
• An Outcome Focussed Collaboration
• 1. Direct GP access to
• MRI scans
• 2. Community based
• Echo
• Ultrasound

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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service

• The Croydon Federation of General Practices
• 16 GP Practices 140,000 patients
• No Direct access to MRI or Echocardiograms
• Local waits for all forms of Ultrasound
• The London NHS Diagnostic service
• Centrally procured to assist in reducing waits
• Available to all GPs in London
• High quality service with quicker access to
  diagnostics
• Patients may have to travel for faster service

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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service

• The Croydon Federation of General Practices
• Feedback from Patients
• Feedback from Referrers
• Need identified for a
• responsive diagnostic service

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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service

• OBJECTIVES
• MRI / Echo / Ultrasound
• Patient access
• Convenience
• Timely
• High Quality
• Value for money
• Appropriate Onward Referrals

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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service

• MEASURES OF SUCCESS (1)
• 1. Access
• Direct Access to MRI
• Direct Access to Echo/Ultrasound
• 2. Convenience
• Choice of six local community ( other London )
  sites
• Choice of time of appointments
• 3. Timely
• Referral to Report time of lt 2weeks (ambitious)

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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service

• MEASURES OF SUCCESS (2)
• High Quality
• Continuous monitoring
• Independent clinical audit
• Referrer Experience Survey
• Appropriate Onward Referrals
• Referral Governance (pre and post) / guidelines
• Routine monitoring and audit
• Value for money
• Added value given same tariff price

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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service

• INNOVATION (1)
• Use of exiting infrastructure
• GP surgery premises ( without charge!)
• Federated model of 16 GP practices
• Sharing Diagnostic resource
• Customised solution
• Direct GP access to MRI locally
• Mobile Echo Ultrasound at GP Surgeries

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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service

• INNOVATION (2)
• Clinician Led
• Can do attitude
• Vision, Service Specification, governance
• Active Project management support, monitoring
• Supportive Diagnostic Provider
• Highly responsive with Outcome focus
• Highly developed Customer Focus

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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service

• INNOVATION (3)
• Overcoming the challenges
• Providing diagnostic capacity for unknown demand
• Creating six diagnostic sites in the community
• Resources and Rostering for six diagnostic sites
• Developing Governance
• From Concept to go-live
• in less than 3 months!

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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service

• Overwhelming GP Practice buy-in

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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service
Six Community based diagnostic sites
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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service
Index of multiple deprivation 2007, Croydon super
output areas
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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service
Patient Choice of Diagnostic Site
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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service
Monthly Demand
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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service
Demand vs Capacity
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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service
Referral to Report times
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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service
Governance - Abnormal Findings (309 scans)
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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service
Reduced Hospital Referrals
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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service
Reduced Hospital Referrals
309 scans (MRI, Echo Ultrasound)
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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service
Reduced Hospital Referrals If direct access /
community diagnostics NOT available would you
have referred to hospital ? ( 231 scans MRI,
Echo and ultrasound)
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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service
Patient Satisfaction Survey Sept 2008
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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service
Referrer Satisfaction Survey Sept 2008
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Croydon Diagnostics in the Community pilot

• London NHS Diagnostic Service

• Referrer Satisfaction Survey Sept 2008

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Croydon Diagnostics in the Community pilot

• London NHS Diagnostic Service

• Referrer Satisfaction Survey Sept 2008

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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service
Value For Money
Added Value
Cost Assurance

• Contract negotiated through DH Commercial Unit
• Subject to formal procurement processes and
  compliant with competition rules and legal
  framework
• Indicative tariff provides vfm benchmark with
  other providers

• 14 day target on referral to report (compared to
  6 week indicator in NHS model contract and 18
  week pathways)
• Quality standards on reporting
• Rolling audit programme to support users and
  inform quality
• Processes to support testing of Patient
  Experience

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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service
Being rolled out..
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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service

• Why we should win
• Needs identified action taken decisively - Can
  do attitude
• Successful Collaboration Responsive provider
• Effective management and leadership
  Ambitious
• Innovative project Care closer to home
  major re-design
• Maximised use of existing resources e.g. GP
  surgeries, contract

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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service

• Why we should win
• Achieved all objectives (Access, Convenience,
  Timely, High Quality, Value for money,
  Appropriate Onward Referral)
• Re-design of Care Pathways MKS, Heart Failure,
  Gynae
• Reduced referrals to hospital management in the
  community
• Improved Patient Access for better healthcare
  closer to home
• Concepts to implementation - less than 3 months
  an NHS first?

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Croydon Diagnostics in the Community pilot
London NHS Diagnostic Service

• Patient Audio patient has the last word